What Will You Do With Your Organs When You Die?

A reform to the General Law of Health (GLH) was passed by the Senate of the Republic, and it is making its way through the Congress of Union. Soon, it could be sent to the President for ratification, to come into force the next day. With the changes, a person whose death was caused by a stroke, or with brain death, would be potential organ donors; this would not happen if the person previously left a will stating that they do not wish to give their organs away.

General Law of Health

Who owns our body when we die? Our relatives or the system? In article 320, the GLH states that “every person owns their body and could partially or completely donate it.” Article 321 is clear and states that such donations—which could mean organs, tissues, cells, or cadavers—“consists in the tacit or expressed agreement (in life or after life) of a person, to use their body or any part of the body with transplantation goals.” The current law also remarks that the expressed donation “ought to be written” and actually it can be in favor of specific people or institutions; the expressed decision could never be revoked by third parties.

Although the law includes a tacit agreement for when person wishes to reject their default status as organ or components, the person did not agree to donate organs or components, now it is clear: “every person owns their body, and could donate it, totally or partially, unless there is a negative written statement against it.” The reformed articles amend Articles 320-326 and 329. The reform, approved initially by the Congress of Union, was approved by the Senate with 75 votes in favor, zero against, and one abstention.

Guanajuato on the cutting edge

In 2017, five relatives of dead persons decided to donate organs at the Hospital of San Miguel de Allende, giving four men from this city a kidney transplant.

Rodrigo López Falcony is the director of the State Center of Transplantations (CETRA)—based in León. The council of his office is made up of the State Secretary of Health, the rector from the Universidad de Guanajuato, the State Attorney General, President of the State DIF, as well as the directors of every public hospital. Falcony told Atención that Guanajuato has been ranked as an avant garde state in terms of donations and that the Health Secretariat has received three distinctions from the National Center of Transplantations. First, Guanajuato has been noted as the state with the biggest number of donors per million; the average is 3.4 and the state has 11 donors. Secondly, the state has the two hospitals from which the most kidneys have been harvested for transplants from cadavers. “We are also a national reference point in transplantations,” Falcony said. “We performed 106 in 2016, and last year we performed 132.”

He also remarked that in Guanajuato the hospitals can transplant corneas, kidneys, and livers. Hospitals in Jalisco, Nuevo León, and Mexico City transplant hearts.

About the Law Reform

Falcony made it clear that when somebody dies, the body belongs to the relatives. If the reform comes into force, he said that all Mexicans (and even expats) who die in a public or private hospital will be considered potential organ donors, unless they left a will stating to the contrary.

However, he highlighted that in Guanajuato, they have done impressive work to convince relatives to allow donations to be taken from their loved ones and that even if the reform comes into force, the human touch should always remain. Doctor Falcony promised that health workers would always ask for relatives’ authorization before touching an organ, because the family has to be the one to make the decision.

Previously the law was “opt in”—that is to say all those willing to donate their body or organs had to leave that desire in writing, and now the law would be “opt out,” meaning that all those not willing to donate need to leave that in writing before their death.

Falcony was clear that many people—at least in Mexico—have a wrong idea on what happens when somebody dies, and that they think that everybody, even the criminals that are murdered on the street, can donate. That is false, he said. Because in order to be a potential donor, the patient has to die in a hospital, since that is where the specialist and the proper equipment for harvesting is. When somebody dies on the street or at home, they are not taken to hospitals but to the Forensic Service, and at those places “there is no personnel for extraction of organs, nor equipment.

With the new reform, even if the person did not leave a negative written statement on donation, the family, being the legal owner of the body, could not debate the law decision. However he strongly remarked “we will never take an organ without taking note of the family’s wishes. If they are against the extraction, we will not touch any organs. We do not want to negatively impact anyone. Nothing supersedes their grieving needs. It is a topic of compassion, heroism, and love for others, and that is what we try to promote in the CETRA.”

Organ Trafficking

Among the taboos in organ donation is the possibility of trafficking. Falcony demystified the idea, stating that for an extraction and a transplantation, at least 30 specialists are needed in an operating room.

“There is no organ trafficking in Mexico. Fortunately, a transplantation is complicated because of the number of people that it requires, as well as the equipment. Extracting an organ from a living person sounds difficult; you would need a corrupt hospital and the personnel to do it, and in Guanajuato all the institutions are well surveilled.”

In the state there are just seven surgeons trained to do transplants. Also, extraction and transplantation requires impressive logistics, and a well-preserved kidney ought to be transplanted within 24 hours; a liver, 12 hours; and a heart, six.

“Today we did have an organ donation. All the organs are transported in the emergency units of the health system,” Falcony said. He also remembered that once they had three jets at the BJX, because the organs had to be delivered to three different states.

Read Interview with the Director of CETRA on page XX.

Statistics in the State

Here we present a chart with the organ donation in the state during 2017; the same year in the state surgeons performed the transplantation of 437 organs—80 kidneys were donated by living persons.

Organ

Total

Kidney

132

Cornea

141

Liver

008

Heart

004

Until March, 2018, the CETRA’s number state that there have been 21 donors, from those, 82 organs and tissue, have been extracted. 102 transplants have been performed, from those 58 have been kidneys (25 donated by living persons.)